Carcinogenesis, Mutagenesis, Impairment Fertility There have been no long-term studies performed animals Pregnancy Teratogenic Effects Pregnancy Category C Animal reproduction studies have not been conducted with digoxm. also not known whether digoxm can cause fetal harm when administered a pregnant woman or can affect reproduction capacity Digoxm should given a pregnant woman only clearly needed. Nursing Mothers Studies have shown that digoxm concentrations the mother's serum i need to write an essay about myself and milk are similar However, the estimated daily dose a nursing infant will far below the usual infant maintenance dose. Therefore, this amount should have no pharmacologic effect upon the infant.
Nevertheless, caution should exercised when digoxin ADVERSE REACTIONS The frequency and seventy adverse reactions digoxm depend the dose and route administration, as well as the patient's underlying disease or concomitant therapies see PRECAUTIONS section. The overall incidence adverse reactions has been reported as, with them being considered serious one four percent patients receiving digoxm Evidence suggests that the incidence toxicity has decreased since the introduction the serum digoxm assay and improved standardization digoxm help on research papers tablets Cardiac toxicity accounts for about one.
haif, gastrointestinal disturbances for about one-fourth, and CNS and other toxicity for about one-fourth these adverse reactions.
Card Unifocal or multiform ventricular premature contractions, especially in bigeminal or trigeminal patterns, are the most common arrhythmias associated with digoxm toxicity in adults example thesis with heart disease. Ventricular tachycardia may result from digitalis toxicity. Atrioventricular AV dissociation, accelerated coursework info junctional nodal rhythm and atrial tachycardia with block are also common arrhythmias caused digoxm overdosage. Excessive slowing the pulse a clinical ghost writer for college papers sign digoxm overdosage.
AV block Wenckebach increasing degree may proceed complete heart Note The electrocardiogram fundamental determining the presence and nature these cardiac disturbances.
Digoxm may also induce other changes the ECG PR prolongation, depression, which represent digoxm effect and may or may not associated with digitalis toxicity. Gastrointestinal norex.
nausea, vomiting and less commonly diarrtiea are common early symptoms overdosage However uncontrolled heart failure may also produce such symptoms Digitalis toxicity very rarely may cause abdominal pain and hemorrhagic necrosis the intestines. CWS Visual disturbances blurred or yellow vision, headache, weakness, Offter Gynecomastia occasionally observed Inlants and Children Toxicity differs from the adult a number respects.
Anorexia, nausea, vomiting, diarrhea and CNS disturbances may present but are rare as initial symptoms mtants Cardiac arrhythmias are more reliable signs toxicity Digoxm in children may produce any arrhythmia.
The most commonly encountered are conduction disturbances or supraventricular tachyarrhythmias, such as atrial tachycardia with or without block, and junctional nodal tachycardia. Ventricular arrhythmias are less common. Smus bradycardia may also a sign impending digoxm intoxication, especially infants, even intheabsenceof first degree heart block. Any arrhythmia or alteration in cardiac conduction that develops in a child taking digoxm should initially assumed a consequence digoxm intoxication. TREATMENT OF ARRHYTHMIAS PRODUCED BY OVERDOSAGE Adults Digoxm should discontinued until all signs toxicity are gone Discontinuation may all that necessary if toxic manifestations are not severe and appear only near the expected time for maximum effect the drug. Potassium salts are commonly used, particularly if hypokalemia present Potassium chloride divided oral doses totaling grams the salt mEq K for adults may given provided renal function adequate see below for potassium recommendations in Infants and Children When correction the arrhythmia urgent and the serum potassium concentration low or normal, potassium should administered intravenously dextrose miection For adults, a total mEq diluted a concentration mEq per may given at a rate not exceeding mEq per hour, or slower limited pain due local irritation Additional amounts may given the arrhythmia uncontrolled and potassium well-toleratedECG monitoring should performed watch tor any evidence potassium toxicity peaking T waves and observe the effect the arrhythmia The infusion may stopped when the desired effect achieved Note Potassium should not used and may dangerous in heart block due digoxm, unless primarily related Other agents that have been used for the treatment digoxm intoxication include lidocame. procainamide, propranolol and phenytoin, although use the latter must considered experimental. In advanced heart bfock, temporary ventricular pacing may beneficial Digoxin Immune Fab Ovine, Digibind, can used reverse potentially lifethreatening digoxm or digitoxin intoxication Improvement in signs and symptoms digitalis toxicity usually begins within hour Digibmd administration Each vial Digibmd will neutralize digoxm which a usual body store an adequately digitalized patient.